Multiple systems organ failure is the common mechanism of death in the multiple trauma patient. We have detailed in several articles the metabolic and physiologic correlates associated with death from the trauma septic state. This death appears to occur in the basis of an altered relationship between mitochondrial and cytoplasmic functions which leads to reduced cytoplasmic high energy phosphate in association with enhanced oxidative catabolism of leucine. These changes occur first in the periphery (? muscle) and then progressively involve the other organs. This year's endeavor will principally aim at measuring total body fluxes of heavy isotope doubly labeled alanine and leucine in association with tissue and systemic hormono-metabolic and physiologic characterization of the patient under varying conditions of exogenous support. One type of support will be that of a branched chain rich amino acid mixture and another the use of acetoacetate. Another set of observations will be made on arteriovenous concentration difference with measured blood flow across the liver and the leg.